Diet quality and associations with motivation and ability to consume a healthy diet among adolescents from urban low-income households in Bangladesh.

In low- and middle-income countries, particularly in urban areas, adolescent diets consist mainly of energy-dense and nutrient-poor foods, putting them at risk of malnutrition and non-communicable diseases (NCD). In Bangladesh, little is known about the diet quality of adolescents, their food choices and the drivers of such choices. This study assessed motivations and ability to consume a healthy diet among adolescent girls and boys from low-income urban families and how these drivers were associated with dietary diversity and diet quality. A cross-sectional survey was conducted among 299 adolescents (15-19 years) from low-income households in Dhaka city during September-October 2020. The Diet Quality Questionnaire was used to collect non-quantitative food intake in the previous day or night to calculate diet quality indicators of food group diversity score, % of adolescents achieving minimum dietary diversity, NCD-Protect and NCD-Risk and the Global Dietary Recommendations score. Motivation was measured by 11 food choice motives. Ability was measured by belief in own ability to engage in healthy eating behaviors (self-efficacy). Adolescent diets showed a mean food group diversity of 4.9 out of 10, with 60% of adolescents achieving minimum dietary diversity, but lacked health-promoting foods (average of 2.7 out of 9 food groups) yet included few foods to avoid and limit (1.6 out of 9). Adolescents valued food choice motive 'safety' the most, followed by 'health', 'taste', 'price', 'convenience' and 'local or seasonal'. A higher motivation to consume 'local or seasonal' and a lower motivation driven by 'price', and a higher perceived self-efficacy were associated with better diet quality. Future interventions should address self-efficacy, concerns about food price and increase local and seasonal foods availability in the urban poor food environment of Dhaka to improve overall diet quality.

Circular food system approaches can support current European protein intake levels while reducing land use and greenhouse gas emissions.

Protein transition and circular food system transition are two proposed strategies for supporting food system sustainability. Here we model animal-sourced protein to plant-sourced protein ratios within a European circular food system, finding that maintaining the current animal-plant protein share while redesigning the system with circular principles resulted in the largest relative reduction of 44% in land use and 70% in greenhouse gas (GHG) emissions compared with the current food system. Shifting from a 60:40 to a 40:60 ratio of animal-sourced proteins to plant-sourced proteins yielded a 60% reduction in land use and an 81% GHG emission reduction, while supporting nutritionally adequate diets. Differences between current and recommended total protein intake did not substantially impact minimal land use and GHG emissions. Micronutrient inadequacies occurred with less than 18 g animal protein per capita per day. Redesigning the food system varied depending on whether land use or GHG emissions were reduced-highlighting the need for a food system approach when designing policies to enhance human and planetary health.

Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria.

Background: Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. Objectives: This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. Methods: We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. Results: The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. Conclusions: We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.

Cost and affordability of healthy diets in Vietnam.

OBJECTIVES: To estimate the cost and affordability of healthy diets recommended by the 2016-2020 Vietnamese food-based dietary guidelines (FBDG). DESIGN: Cross-sectional analysis. The Cost of a Healthy Diet (CoHD) indicator was used to estimate the lowest cost of healthy diets and compare the cost differences by food group, region and seasonality. The affordability of healthy diets was measured by further comparing the CoHD to food expenditures and incomes. SETTING: Food prices of 176 food items from January 2016 to December 2020 were derived using data from monthly Consumer Price Index databases nationally and regionally. PARTICIPANTS: Food expenditures and incomes of participants from three latest Vietnam Household Living Standard Surveys were used. RESULTS: The average CoHD between 2016 and 2020 in Vietnam was 3·08 international dollars using 2017 Purchasing Power Parity (24 070 Vietnamese Dongs). The nutrient-rich food groups, including protein-rich foods, vegetables, fruits and dairy, comprised approximately 80 % of the total CoHD in all regions, with dairy accounting for the largest proportion. Between 2016 and 2020, the cheapest form of a healthy diet was affordable for all high-income and upper-middle-income households but unaffordable for approximately 70 % of low-income households, where adherence to the Vietnamese FBDG can cost up to 70 % of their income. CONCLUSIONS: Interventions in local food systems must be implemented to reduce the cost of nutrient-rich foods to support the attainment of healthier diets in the Vietnamese population, especially for low-income households.

Determinants of dietary diversity and drivers of food choice among low-income consumers in urban Kenya, Malawi and Zimbabwe.

INTRODUCTION: Rapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low-income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies. METHODS: Mixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low-income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio-demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker® (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24-h recall, which was then converted to the food group diversity score (FGDS). RESULTS: Different levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut-off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo. DISCUSSION/CONCLUSIONS: Our observation of poor-quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low-income environment.

Environmental impact and nutrient adequacy of derived dietary patterns in Vietnam.

Rationale and objective: Improving diet quality while decreasing environmental impacts is an important challenge for a healthy and sustainable food system. Therefore, this study aims to analyze the most common dietary patterns per female household member and explore the diet quality and environmental impacts of these patterns. Methodology: The nationally representative General Nutrition Survey of 2009-2010 (n = 8,225 households) was used to derive dietary patterns using principal component analysis (PCA) based on 18 food groups as input variables. Quintiles of the highest adherence (Q5) and lowest adherence (Q1) were generated based on the factor score of each dietary pattern. Nutrient adequacy and dietary diversity scores (DDS) were calculated to measure diet quality, and greenhouse gas emission (GHGE) and blue water use (BWU) were selected as environmental impact indicators. Results: Using PCA, three distinct dietary patterns were identified: an Omnivorous, Traditional, and Pescatarian pattern. Compared to the Traditional pattern, the Omnivorous and Pescatarian patterns (Q5s) were associated with a higher nutrient adequacy, with mean probability of adequacy of 0.51 in both patterns, compared to 0.45 in the Traditional pattern. However, environmental impacts in terms of GHGE and BWU per 2,000 kcal were considerably higher in the Omnivorous pattern (6.14 kg CO2-eq. and 0.15 m3/kg) compared to all other pattern's Q5s. The GHGE was lowest in the Traditional pattern (4.18 kg CO2-eq.) and the Pescatarian pattern has the lowest BWU (0.12 m3/kg). Conclusion: Despite that diet quality was slightly better in all three patterns compared to the average diet of the total population, environmental impact was also higher. Therefore, future research is needed to develop a more optimal diet that considers both diet quality and environmental impact to explore the trade-offs between diet quality and environmental impact.

A simple fruit and vegetable score is a valid tool to assess actual fruit and vegetable intake.

With the recent growing interest in improving fruit and vegetable intake for better health and limited research resources in many settings, simple-to-administer and low-priced indicators are essential tools for monitoring fruit and vegetable intake at the population level. A potential candidate indicator is the fruit and vegetable component of the Global Dietary Recommendation score (FV-GDR) based on data collected using the Diet Quality Questionnaire (DQQ). We investigated the relative validity of FV-GDR collected with the DQQ to measure fruit and vegetable intake by comparison with a 24-h recall (24hR) as a reference collected from 620 Vietnamese and 630 Nigerian adults in 2021. We found proportional differences in the prevalence of intake of vitamin A-rich vegetables, other vegetables and other fruits in Vietnam and all vegetable food groups in Nigeria. In both countries, we found a small difference in the total FV-GDR from DQQ compared with the 24hR, and the percentage of agreement between the two methods was quite high for the majority of the food groups. The FV-GDR calculated from the DQQ correlated with the actual intake, although less strongly than the FV-GDR from 24hR. The DQQ is a promising low-burden, low-cost and simple tool to calculate FV-GDR and to monitor fruit and vegetable consumption at the population level. This provides the possibility of evaluating an important aspect of diet quality in low-resource settings.

[The value of SpO2 measurement in young infants in the primary care setting]. / De waarde van pulsoximetrie bij zuigelingen.

Hypoxia can be an early sign of infection, respiratory or circulatory pathology in infants. Since it is difficult to properly judge oxygen saturation solely by skin discoloration, it is preferable to objectify this parameter via pulse oximetry (PO). PO in young infants has shown to be feasible in the primary care setting. Even though PO is broadly used by general practitioners (GPs) in older children and adults, it is rarely performed in young infants. We present three patients, aged 0 to 6 months, who were seen in primary care, where PO was an important factor in determining the level of illness. These patients illustrate the value of PO in infants by GPs in estimating illness severity, need for referral and mode of transport to the emergency department. We therefore advocate for GPs to obtain adequate equipment for PO in infants.

The DQQ is a Valid Tool to Collect Population-Level Food Group Consumption Data: A Study Among Women in Ethiopia, Vietnam, and Solomon Islands.

BACKGROUND: The Diet Quality Questionnaire (DQQ) is a rapid dietary assessment tool designed to enable feasible measuring and monitoring of diet quality at population level in the general public. OBJECTIVES: To evaluate validity of the DQQ for collecting population-level food group consumption data required for calculating diet quality indicators by comparing them with a multipass 24-h dietary recall (24hR) as the reference. METHODS: Cross-sectional data were collected among female participants aged 15-49 y in Ethiopia (n = 488), 18-49 y in Vietnam (n = 200), and 19-69 y in Solomon Islands (n = 65) to compare DQQ and 24hR data in proportional differences in food group consumption prevalence, percentage of participants achieving Minimum Dietary Diversity for Women (MDD-W), percent agreement, percentage misreporting food group consumption, and diet quality scores of Food Group Diversity Score (FGDS), noncommunicable disease (NCD)-Protect, NCD-Risk, and the Global Dietary Recommendation (GDR) score using a nonparametric analysis. RESULTS: The mean (standard deviation) percentage point difference between DQQ and 24hR in population prevalence of food group consumption was 0.6 (0.7), 2.4 (2.0), and 2.5 (2.7) in Ethiopia, Vietnam, and Solomon Islands, respectively. Percent agreement of food group consumption data ranged from 88.6% (10.1) in Solomon Islands to 96.3% (4.9) in Ethiopia. There was no significant difference between DQQ and 24hR in population prevalence of achieving MDD-W except for Ethiopia (DQQ 6.1 percentage points higher, P < 0.01). Median (25th-75th percentiles) scores of FGDS, NCD-Protect, NCD-Risk, and GDR score were comparable between the tools. CONCLUSIONS: The DQQ is a suitable tool for collecting population-level food group consumption data for estimating diet quality with food group-based indicators such as the MDD-W, FGDS, NCD-Protect, NCD-Risk, and GDR score.

How did the COVID-19 pandemic affect food environment, food purchase, and fish consumption among low-income urban households in Bangladesh-A path analysis.

Background: Animal source foods, especially fish is the most commonly consumed and an important source of macro and micronutrients in the diet of the urban low-income residents. The COVID-19 pandemic has disrupted the food environment in Bangladesh but little is known about how food access and food prices (affordability) have affected the purchase and consumption of fish. The objective of the study was to understand the impact of the first wave of the COVID-19 pandemic on urban food environment with a specific focus on fish consumption. Methods: A cross-sectional survey was conducted among 586 homogeneous adults (288 females and 298 males) from separate households from five informal settlements in Dhaka city, Bangladesh during October-November 2020. Data were collected on: (1) food access and affordably; and (2) food purchase and fish consumption. The associations between food access, price, food purchase, and fish consumption were evaluated using path analysis. Results: The majority of respondents reported that food access was more difficult, food prices increased, and food purchase decreased during the COVID-19 pandemic compared to pre-COVID (84-89% of respondents). Fish and meat were more difficult to access, more expensive and purchased less compared to other foods (74-91% of respondents). Compared to pre-COVID period, households consumed less fish during the COVID-19 pandemic, and reported compromised the variety and quality of fish. In the path analysis, food access was associated with food purchase (b = 0.33, p < 0.001). Food purchase was associated with quantity, variety, and quality of fish consumed. Food price was inversely associated with the quality of fish consumed (b = -0.27, p < 0.001). Conclusions: The COVID-19 pandemic negatively affected the food environment, particularly food access, price (affordability), purchase, and consumption, especially of fish. Limited food access negatively affected the quantity, variety and quality of fish consumed. An increase in food prices directly affected the quality of fish consumed. Policy actions are essential to ensure equal access to nutritious foods, such as fish. These policies need to focus on diversity and quality along with preventing increases in food prices during emergencies to mitigate future threats to the nutrition and health of the urban low-income residents.

Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis.

OBJECTIVE: Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks. SETTING: Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES: We analysed intentions and plans of the government to act, using policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008 and 2020. Our coding framework was guided by the policy component (n=7 domains) of the Healthy Food-Environment Policy Index, which was modified to include food quality and safety as an eighth domain. RESULTS: From the 127 policy outputs identified, 38 were retained, published by 9 different government ministries and institutions. Our results show that eight food environment domains have been addressed to some extent, but gaps remain compared with global best practice, especially in food promotion, processing, retail, price and trade. From 2018, policy began to embrace the wider food system, with more explicit food environment interventions becoming apparent. CONCLUSIONS: Policy efforts achieved in food safety, food processing, marketing and labelling are important stepping stones to building future policy actions addressing the food environment domains of food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in the context of multiple forms of malnutrition.

Development of the Vietnamese Healthy Eating Index.

Poor dietary quality is a major contributor to malnutrition and disease burden in Vietnam, necessitating the development of a tool for improving dietary quality. Food-based dietary guidelines (FBDGs) have been proposed to do this by providing specific, culturally appropriate and actionable recommendations. We developed the Vietnamese Healthy Eating Index (VHEI) to assess the adherence to the 2016-2020 Vietnamese FBDGs and the dietary quality of the general Vietnamese population. This VHEI consists of eight component scores, 'grains', 'protein foods', 'vegetables', 'fruits', 'dairy', 'fats and oils', 'sugar and sweets' and 'salt and sauces', representing the recommendations in the FBDGs. Each component score ranges from 0 to 10, resulting in a total VHEI score between 0 (lowest adherence) and 80 (highest adherence). The VHEI was calculated using dietary intake data from the Vietnamese General Nutrition Survey 2009-2010 (n = 8225 households). Associations of the VHEI with socio-demographic characteristics, energy and nutrient intakes and food group consumptions were examined. The results showed that the mean and standard deviation score of the VHEI was 43⋅3 ± 8⋅1. The component 'sugar and sweets' scored the highest (9⋅8 ± 1⋅1), whereas the component 'dairy' scored the lowest (0⋅6 ± 1⋅6). The intake of micronutrients was positively associated with the total VHEI, both before and after adjustment for energy intake. In conclusion, the VHEI is a valuable measure of dietary quality for the Vietnamese population regarding their adherence to the FBDGs.

Environmental footprints of Chinese foods and beverages: Literature-based construction of a LCA database.

To accurately estimate and model the impact of food consumption and potential dietary changes on environment and climate change, the need for country specific data is evident. This study developed a Chinese Food Life Cycle Assessment Database (CFLCAD) in which Greenhouse Gas Emissions (GHGE) for 80 food items, Water Use (WU) for 93 food items and Land Use (LU) for 50 food items were collected through a literature review. To estimate the environmental footprints of food from production to consumption, the study applied conversion factors for the edible portion of food, food loss ratio and processing, storage, packaging, transportation, and food preparation stages. In addition, when no LCA data of a certain food was available, data from food groups with similar nutritional composition or cultivation condition were used as proxies. The database covered 17 food groups and each food item was referenced to the Chinese Food Composition Table and has a unique food code. The CFLCAD can be used to link individual-level food consumption data with nutrition survey in China, to allow for a more accurate estimation of the environmental footprints of Chinese diets.

Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda.

BACKGROUND: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers' practices that enact or impede nutrition integration in services and the conditions galvanizing them. METHODS: This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts. RESULTS: Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic 'jobs worth'. Integrative practices are driven mostly by donors. CONCLUSION: Understanding frontline workers' practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning.

Factors Influencing Adolescents' Dietary Behaviors in the School and Home Environment in Addis Ababa, Ethiopia.

Background: Malnutrition affects many adolescents in Ethiopia. Over one-third of adolescent girls and two-thirds of boys are thin. Overweight and obesity in Ethiopia is mostly a concern in urban populations of higher wealth quintiles. Urbanization and globalization of diets is shifting food environments. The objective of this study was to assess whether food environments in and around schools in urban Ethiopia influence dietary diversity, quality, BMI status or perceptions of adolescents. Methods: Twelve high schools were selected in Addis Ababa (private/government). From each school, 20 pupils aged 15-19 years were randomly selected (n = 217) and interviewed about assets in their households, their diets (categorized into 10 food groups of the Minimum Dietary Diversity, the Global Dietary Recommendations scores and four categories of the NOVA classification based on level of processing) and their use of pocket money. In addition, food environment audits were conducted within the school compound and a 0.5 km radius around each school and types of food outlets. Results: On average there were 436 food outlets and 246 food or drink advertisements around each school. The majority of the advertisements (89.9%) were of ultra-processed foods, mostly sugar-sweetened beverages (SSBs). Most were positioned on food outlets (89.1%). SSBs or sweets were visibly on display in 26.3% of the outlets and fresh fruits and vegetables in 17.9% of outlets. Dietary diversity of adolescents was poor with an average of 3.6 food groups out of 10 consumed in the last 24 h. Ultra-processed foods and beverages were consumed by 23.5% of adolescents. The majority of adolescents spent their pocket money on SSBs, sweets or fried foods. Our analysis found that higher assets in adolescents' households were associated with higher dietary diversity and consumption of healthy food groups. We found no association between the food environment and dietary indicators or the BMI-z-score. Conclusion: While the school food environments investigated were not conducive with promoting healthy dietary behaviors, we cannot conclude that these environmental factors directly influence adolescents' diets. The pervasive advertising and availability of unhealthy foods and beverages requires policy action for healthy school food environments.

Implementation of Nationwide Evidence- and Consensus-Based Guidelines to Harmonize Neonatal Care in The Netherlands.

BACKGROUND: A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensus-based guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent. OBJECTIVE: This study investigated to what extent the guidelines were implemented and which factors played a role in implementation. STUDY DESIGN: A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semi-structured interviews, perceived barriers and facilitators for implementation were explored. PARTICIPANTS: Fellows and neonatologists working at all ten Dutch level 3-4 NICUs were eligible. RESULTS: On an average, NICUs implemented 12.6 (of 19) guidelines (range 6-17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation). CONCLUSION: The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.

Circularity in animal production requires a change in the EAT-Lancet diet in Europe.

It is not known whether dietary guidelines proposing a limited intake of animal protein are compatible with the adoption of circular food systems. Using a resource-allocation model, we compared the effects of circularity on the supply of animal-source nutrients in Europe with the nutritional requirements of the EAT-Lancet reference diet. We found the two to be compatible in terms of total animal-source proteins but not specific animal-source foods; in particular, the EAT-Lancet guidelines recommend larger quantities of poultry meat over beef and pork, while a circular food system produces mainly milk, dairy-beef and pork. Compared with the EAT-Lancet reference diet, greenhouse gas emissions were reduced by up to 31% and arable land use reduced by up to 42%. Careful consideration of the feasible substitutability between animal-source foods is needed to define potential roles of animal products in circular human diets.

Nourishing Hope? Changes in Malnutrition and Changes in Girls' Aspirations-Evidence From the Suaahara II Adolescent Girls Panel in Nepal.

PURPOSE: Malnutrition is a pressing public health challenge in South Asia with adverse consequences for adolescent girls' well-being and, potentially, aspirations as drivers of developmental progress. This study aimed to investigate associations between changes in malnutrition and changes in girls' aspirations in key life domains. METHODS: We analyzed two-period panel data from the Suaahara II Adolescent Girls Panel (10-19 years) in Nepal (2018-2019, n = 613). Height, weight, blood samples, 24-hour dietary recalls, and indicators of girls' educational, occupational, marital, and fertility aspirations were collected. Height-for-age z-scores, body mass index-for-age z-scores, hemoglobin concentration (Hb g/dL), and dietary diversity scores for women were calculated. Through cluster-robust fixed-effects regressions, we examined whether changes in thinness (body mass index-for-age z-scores < -2 standard deviation), anemia (Hb <115 g/L nonpregnant <11 years; Hb <120 g/L nonpregnant >12 years; Hb <110 g/L pregnant), and reaching minimum dietary diversity for women were associated with changes in educational, marital, or fertility aspirations. RESULTS: A change from thinness to no thinness increased girls' aspired ages of having a first child by 2.77 years (standard error [SE] 1.22, p = .025). A change from anemia to no anemia increased girls' aspired years of education by .54 (SE .27, p = .044). This association was stronger for postmenarche girls (b -.62, SE .29, p = .035). No associations were found between changes in minimum dietary diversity for women and any of the aspirations. CONCLUSIONS: Thinness and anemia were negatively associated with adolescent girls' aspirations in domains of fertility and education. Multisectoral integrated policies and programs that improve adolescent nutritional status and diets have the potential to foster adolescent girls' aspirations and thereby increase their future potential.

Unravelling adolescent girls' aspirations in Nepal: Status and associations with individual-, household-, and community-level characteristics.

BACKGROUND: Adolescents' aspirations have potential to influence their present and future well-being. Limited knowledge exists on adolescent girls' aspirations and their determinants, particularly in low-income contexts. METHODS AND FINDINGS: Using cross-sectional data, collected in 2018 in Nepal, within the Suaahara II Adolescent Panel Survey, (n = 840), adolescent girls' aspirations in several domains-education, occupation, marriage, fertility, health, and nutrition-were described. Regression models were estimated to explore associations between individual, household and community characteristics and these aspirations for all adolescents and separately for younger (10-14 years) and older (15-19 years) girls. Age, school attendance, and self-efficacy, as well as household wealth, caste/ethnicity, size, and agro-ecological zone of residence were significantly associated with aspirations, although effect sizes and significance varied by aspiration domain and age group. CONCLUSIONS: Findings underscore the curtailing effect of poverty on aspirations and the dynamic nature of aspirations. Initiatives to foster girls' aspirations must address both individual and contextual factors.

A complementary food supplement from local food ingredients to enhance iron intake among children aged 6-59 months in Benin.

Nutritious complementary feeding is often not affordable in Benin, and iron deficiency exists. This research aimed at formulating an affordable and sensory acceptable complementary food supplement using local food ingredients to increase iron intake among children aged 6-59 months in Benin. The complementary food supplement was formulated to ensure that 10 g would cover 25% of the estimated average requirements for iron for children aged 6 to 12 months. Adansonia digitata fruit pulp, Moringa oleifera leaf powder, and Cochlospermum tinctorium root powder were used to compose the complementary food supplement, which was mixed with maize and sorghum ogi porridges before being presented to the mothers and children for the acceptability test. The mineral contents of Adansonia digitata fruit pulp in mg/100 g dw were 9.9 ± 0.1 for iron and 0.9 ± 0.1 for zinc. The iron and zinc contents of Moringa oleifera leaf powder and Cochlospermum tinctorium root powder in mg/100 g dw were 34.1 ± 2.2 and 26.8 ± 2.7 and 9 ± 0.0 and 0.9 ± 0.0, respectively. The complementary food supplement contained, in mg/100 g dw, 17.4 ± 1.1 of iron and 1.2 ± 0.1 of zinc. The maize and sorghum ogi porridges enriched with the complementary food supplement at substitution rates of 15% and 16% (in dry weight), respectively, were acceptable to 85% of children for sorghum ogi porridge and 87% for maize ogi porridge. The present study demonstrated the potential of local food ingredients in the formulation of an iron-rich and acceptable complementary food supplement for children aged 6-59 months in Benin.